Dr. Sethi's Slides

Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies NC ANR Academy for the 21st Century Extension Professional September 9-11, 2020

Ajay K. Sethi, PhD, MHS Associate Professor, Population Health Sciences Faculty Director, Master of Public Health Program University of Wisconsin-Madison Agenda for Part 1

• Presentation (25 minutes): • Examples of public health conspiracies • Factors contributing to the adoption and spread of misinformation • Sources of disinformation • Small groups (30 minutes): Why are some conversations that aim to address misinformation more productive than others? • Reconvene and group discussion (25 minutes) • Break (10 minutes)

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Definitions

Misinformation. Incorrect information spread by well- intentioned individuals

Disinformation. Incorrect information spread deliberately to others

Conspiracy. A secret plan made by two or more people to do something that is harmful or illegal

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies On the 40th anniversary of the moon landing, TIME magazine took a closer look at ten of the world's most enduring conspiracy theories. Their list included:

1. The JFK Assassination 2. 9/11 Cover-Up 3. Area 51 and the Aliens 4. Paul is Dead 5. Secret Societies Control the World 6. The Moon Landings Were Faked 7. Jesus and Mary Magdalene 8. Holocaust Revisionism 9. The CIA and AIDS 10. The Reptilian Elite

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Medical Conspiracy Theories and Health Behaviors in the United States (Oliver and Wood, 2014)

Neither Heard agree nor Medical conspiracy theory narrative before Agree disagree Disagree The FDA is deliberately preventing the public from getting natural cures 63 37 31 32 for cancer and other diseases because of pressure from drug companies.

Health officials know that cell phones cause cancer but are doing nothing to 57 20 40 40 stop it because large corporations won’t let them.

The CIA deliberately infected large numbers of African Americans with HIV 32 12 37 51 under the guise of a hepatitis inoculation program. The global dissemination of genetically modified foods by Monsanto Inc is part of a secret program, called Agenda 21, launched by the Rockefeller and 19 12 46 42 Ford foundations to shrink the world’s population. Doctors and the government still want to vaccinate children even though they 69 20 36 44 know these vaccines cause autism and other psychological disorders.

Public water fluoridation is really just a secret way for chemical companies to 25 12 41 46 dump the dangerous byproducts of phosphate mines into the environment.

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies JAMA Internal Medicine 2014 174(5) Some COVID-19 Conspiracies

Claims without credible evidence Coupled with other agendas • The epidemic is a hoax • COVID-19 is caused by the rollout of 5G • The virus was created in a lab and escaped • COVID is part of a dastardly Gates-led • The virus was created as a biological weapon plot to vaccinate the world’s • The U.S. military imported it into China population • Hydroxychloroquine was not approved by the • COVID-19 is being downplayed or FDA as COVID treatment, but remdesivir was. exaggerated to influence the 2020 • Hospitalization reporting taken over by HHS election from CDC to downplay impact of epidemic. • Plandemic • Medical Deep State Claims with some credible evidence • Reports of data manipulation in Texas, Virginia, Vermont, Florida, Georgia, and Arizona.

“Although it is common to disparage adherents of conspiracy theories as a delusional fringe of paranoid cranks, our data suggest that medical conspiracy theories are widely known, broadly endorsed, and highly predictive of many common health behaviors. Rather than viewing medical conspiracism as indicative of a psychopathological condition, we can recognize that most individuals who endorse these narratives are otherwise ‘normal’ and that conspiracism arises from common attribution processes.”

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Are you a conspiracy theorist?

Are you capable of conspiratorial thinking?

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Factors contributing to the adoption and spread of misinformation

• Mistrust (or, distrust) of people or an organization in a position of authority

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Where does mistrust in health interventions come from?

• Failures in public health and medicine • Flint Water Crisis • 2015 Gold King Mine waste water spill • Tuskegee Syphilis study • Unintended consequences • Hepatitis C transmission in Egypt • SV40 contaminated polio vaccine in the 1950s • Conspiracy • Wakefield’s conflict of interest and falsified data • Merck’s withholding of information on adverse effects related to Vioxx • Operation Neptune Spear

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Factors contributing to the adoption and spread of misinformation

• Mistrust (or, distrust) of people or an organization in a position of authority • Internal conflict with the notion of public health

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies The 10th Amendment to the U.S. Constitution: "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

Jacobson v. Massachusetts (1905) upheld state's rights to exert police powers to enforce mandatory vaccination laws, thus justifying the restriction of individual freedoms for the collective health of a community.

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Pox: An American History by, Michael Willrich

At the turn of the 20th century, there were little to no regulations governing the pharmaceutical industry. Many people were forced to receive the vaccine — most of the time against their will.

A 1901 smallpox vaccination raid in New York — when 250 men arrived at a Little Italy tenement house in the middle of the night and set about vaccinating everyone they could find.

"There were scenes of policemen holding down men in their night robes while vaccinators began their work on their arms," […] "Inspectors were going room to room looking for children with smallpox. And when they found them, they were literally tearing babes from their mothers' arms to take them to the city pesthouse [which housed smallpox victims.]"

"There was one episode in Middlesboro, Ky., where the police and a group of vaccinators went into this African- American section of town, rounded up people outside this home, handcuffed the men and women and vaccinated them at gunpoint," says Willrich. "It's a shocking scene and very much at odds with our daily-held notions of American liberty.”

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Factors contributing to the adoption and spread of misinformation

• Mistrust (or, distrust) of people or an organization in a position of authority • Internal conflict with the notion of public health • Fear and loss of control

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Time magazine article covering this research: Conspiracy theories often crop up during times of uncertainty and fear: after terrorist strikes, financial crises, high-profile deaths and natural disasters. Past research suggests that if people feel they don’t have control over a situation, they’ll try to make sense of it and find out what happened. “The sense-making leads them to connect dots that aren’t necessarily connected in reality,” van Prooijen says. […] "But the essence of conspiracy theorizing is, I think, universal in human beings. People have a natural tendency to be suspicious of groups that are powerful and potentially hostile."

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Factors contributing to the adoption and spread of misinformation

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Sources and Perceptions of Facts; Engagement in COVID-19 News

Source: Pew Research Center; June 29, 2020 Factors contributing to the adoption and spread of misinformation

• Mistrust (or, distrust) of people or an organization in a position of authority • Internal conflict with the notion of public health • Fear and loss of control • Binary thinking and cognitive shortcuts • Confirmation bias • Personal experience/understanding superseding the objective reasoning • Maladaptive coping and psychological vulnerability

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Example of maladaptive coping and psychological vulnerability: HIV Denialism

• AIDS denialism in the scientific community: Peter Duesberg, Kary Mullis • Social psychologist, Seth Kalichman: "A paradox of AIDS denialism is that while its message is completely detached from the objective reality of AIDS, it can be quite convincing. [...]AIDS Denialists rely on well- defined tactics to confuse people about the cause of AIDS and persuade them to ignore the medical consensus on prevention, diagnosis, and treatment.” • Strategies used by AIDS denialists to susceptible individuals include morphing science, cherry picking, single study fallacy.

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Factors contributing to the adoption and spread of misinformation

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Sources of Disinformation: Doubt Creators

Social Bots and Trolls: • Bots and trolls created discord to legitimize vaccine debates (Broniatowski 2018) • Nearly half of accounts tweeting about coronavirus are likely bots (Carley 2020)

Pre-Bot era: • KGB-led disinformation campaign implying that the CIA spread HIV in Black communities • A Frank Statement to Cigarette Smokers from the Tobacco Industry Research Committee

Individuals and organizations with unchecked self-interest

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Small Groups (30 minutes)

Goal: Why are some conversations that aim to address misinformation more productive than others? Specific questions to consider: 1. What might cause a conversation that addresses misinformation to go in the wrong direction? 2. What hot-button subjects do you avoid (or should be avoided)? 3. What is your self-efficacy to have a conversation about a public health- related topic (or anything, in general) with someone whose views are different from your own? 4. What are some of your strengths to having a productive conversation?

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Break for 10 minutes

NC ANR Academy for the 21st Century Extension Professional September 9-11, 2020 Addressing COVID-19 Misinformation

NC ANR Academy for the 21st Century Extension Professional September 9-11, 2020

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies Agenda for Part 2

• Presentation (25 minutes): • Common areas of misinformation • What organizations/companies are doing to address misinformation. • What skills individuals need to address misinformation “one conversation at a time” • Small groups (25 minutes): What kind of COVID-related misinformation spreads in your communities and what are some strategies to address it? • Reconvene and group discussion (25 minutes) • Wrap up (10 minutes)

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Some COVID-19 Conspiracies

Claims without credible evidence Coupled with other agendas • The epidemic is a hoax • COVID-19 is caused by the rollout of 5G • The virus was created in a lab and escaped • COVID is part of a dastardly Gates-led • The virus was created as a biological weapon plot to vaccinate the world’s • The U.S. military imported it into China population • COVID-19 is being downplayed or • Hospitalization reporting taken over by HHS exaggerated to influence the 2020 from CDC to downplay impact of epidemic. election • Plandemic Claims with some credible evidence • Medical Deep State • Reports of data manipulation in Texas, Virginia, Vermont, Florida, Georgia, and Arizona.

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation 49,421 Publications about COVID-19 in PubMed (as of September 7, 2020) Doubling time ~ 60 days

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Who is coming across and susceptible to adopting and spreading misinformation?

• Scientists, public health workers, health care professionals, working professionals • Patients, members of the community, their families • Decision-makers, local leaders, politicians • Everyone

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Common areas of misinformation for the scientific, public health, and health care communities and the general public

• Trends in and predictions of cases, hospitalizations, and deaths • Differences in risk by age, race/ethnicity, and comorbidities • Infectiousness and routes of transmission • Effectiveness of mitigation strategies • Prophylaxis and treatment options • Scope and any long-term effects of infection • Vaccine timeline and future effectiveness • Evidence of recovery, cure, possibility of reinfection, and herd immunity

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation What organizations/companies are doing to address misinformation

• Fact-checking organizations • News organizations • Health systems • Public health agencies • Social media companies

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Fact-checking misinformation

Source: IFCN/CoronavirusFactsAlliance

https://www.poynter.org/coronavirusfactsalliance/ Fact-checking misinformation

Source: IFCN/CoronavirusFactsAlliance

https://www.poynter.org/coronavirusfactsalliance/ Institutions and Agencies Social Media Companies Addressing Misinformation

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Dear Pandemic on Facebook and Twitter Addressing Misinformation

Misinformation. Incorrect information spread by well- intentioned individuals

Disinformation. Incorrect information spread deliberately to others

Conspiracy. A secret plan made by two or more people to do something that is harmful or illegal

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Addressing misinformation one conversation at a time

• Whether a person is actually correct in their thinking or not, from their perspective, it’s the other person who is misinformed, and vice versa. • Do not ignore misinformation when doing so can result in harm to an individual. • Address misinformation only when your conversation moves things in a positive direction for the individuals with whom you engage and for yourself.

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Addressing misinformation one conversation at a time

• Feel empathy for people who become misinformed. • Establish trust. • Listen actively to get to know where people are coming from. • Maintain a healthy detachment when listening. • Identify shared interests and values. • Seek out credible sources of information. • Avoid thinking that educating someone is the immediate solution. • Changing someone’s mind is not the goal of a conversation. • Improve communicating of risk and know when to say, “I don’t know.”

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Avoiding Misinformation

• Recognize uncertainty. Let new information play out before drawing a conclusion, if at all. • Demand objectivity. Reflect on whether the source has a conflict of interest with the information that is being shared. • Take control. Rather than let sources of news dictate what you see and consume, take a step back, reflect on what you would like to know more about, and research it with credible sources of information and open mind. • Outsource. Let trusted experts whose living is to sift through information do the job for you.

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Small Groups (30 minutes)

Goal: What kind of COVID-related misinformation spreads in your communities and what are some strategies to address it?

Topic 1: Origin of the virus Topic 2: Treatments Topic 3: Significance of the pandemic (e.g., no different than the flu) Topic 4: COVID surveillance

Specific questions to consider: • Have you personally found yourself misinformed or confused about the assigned topic? If so, what did you find confusing? • What kinds of misinformation related to the topic have you seen spread in the communities where you work and serve? • Where would you go for accurate information about the assigned topic? • What would be your approach to help others who are misinformed about the topic?

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Reconvene for Group Discussion (25 minutes)

Goal: Misinformation that spreads in your communities and strategies to address it Topic 1: Origin of the virus Topic 2: Treatments Topic 3: Significance of the pandemic (e.g., no different than the flu) Topic 4: COVID surveillance

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Origin of the Virus

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Treatments for COVID-19

At-home treatment: Rest, staying home, fluids, fever reducer, monitor for worsening symptoms

Treatment in the hospital: Remdesivir – antiviral may be given to patients with severe illness Convalescent plasma – plasma donated by recovered patients to treat currently ill patients Corticosteroids – anti-inflammatory/immunosuppressive treatment may be given to patients with severe illness Prone positioning – placing ill patients on their stomach helps increase the amount of oxygen that reaches their lungs

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Comparing COVID-19 with Seasonal Flu

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation COVID-19-associated deaths

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Leading Causes of Death in the U.S., 2018

• Heart disease (655,381) COVID-19 will be the #3 cause of • Cancer (599,274) death for 2020 • Unintentional injury (167,127) • Chronic lower respiratory disease (159,486) • Stroke (147,810) • Alzheimer's disease (122,019) • Diabetes (84,946) • Flu and pneumonia (59,120) Either nephritis or suicide will not • Nephritis (51,386) be among the ten leading causes of • Suicide (48,344) death in 2020

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Is a picture worth a thousand words?

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Can the COVID-19 pandemic be described with sixteen metrics?

• # cases identified on a given day • 7- and 14-day average of # cases/day • Cumulative number of cases identified • Rate per capita of COVID+ cases identified on a given day • % COVID+ tests on a given day • 7- and 14-day average of % COVID+ tests • % cases contacted within 48 hours of testing • % cases who are unaware of how they acquired infection • # individuals hospitalized on a given day • # deaths that have occurred on a given day • Cumulative deaths that have occurred • # COVID+ HCWs • Healthcare system burden • Number and nature of outbreaks in facilities • Distribution of cases by age, sex, and race/ethnicity • County-specific and census tract-specific number of cases

NCR Academy 2021 Workshop Addressing COVID-19 Misinformation Wrap-up

NC ANR Academy for the 21st Century Extension Professional September 9-11, 2020

Ajay K. Sethi, PhD, MHS Associate Professor, Population Health Sciences Faculty Director, Master of Public Health Program University of Wisconsin-Madison Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies and Addressing COVID-19 Misinformation Wrap-up: What causes us to adopt misinformation and disinformation?

• Tendency to live in bubbles and echo chambers • During times of crisis, fear and uncertainty can lead to feelings of losing control • Denialism feels easier when facing something that is daunting • We might seek out and adopt ideas that make us feel better • Confirming our views is easier than searching disconfirming information • Personal experience influences our worldview • Humans have a “default” for binary thinking and taking cognitive shortcuts • Growing culture to dismiss experts • Doubt creators can be very convincing

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies and Addressing COVID-19 Misinformation Wrap-up: My choices for Information on COVID-19

• Peer-reviewed medical literature • Dane County Public Health website and blog, Wisconsin Department of Health Services, Centers for Disease Control and Prevention, World Health Organization • Consensus statements from professional organizations • Medical news aggregators (e.g.,MedPage Today, MedScape) • Select newspapers • Seminars and webinars • Twitter content from key opinion leaders or credible organizations • Dear Pandemic (Facebook; Twitter)

Note: • Avoid news sites that do not have a credible “About Us” page. • Avoid news reported by “personalities” vs. investigative journalists • Avoid secondhand information from non-credible individuals and organizations

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies and Addressing COVID-19 Misinformation Wrap-up: Where to go from here (where to begin?)

• Be mindful of the negative aspects of our current infodemic. • Distinguish disinformation from misinformation, and focus energy on reducing the former. • Stop disparaging people whose are misinformed views on health interventions that are different from our own • Educate ourselves about popular and less popular conspiracy theories and their origins • Address misinformation one conversation at a time, but only when these conversations move things in a positive direction. • Become better listeners and communicators of risk • Remind ourselves and others how to avoid confirmation bias • Be honest with ourselves and the public about our society’s failures to protect people’s health • Seek out and encourage others to rely on credible sources of information.

NCR Academy 2021 Workshop Exploring the Basis for Public Health Misinformation, Disinformation, and Conspiracies and Addressing COVID-19 Misinformation Thank you.

NC ANR Academy for the 21st Century Extension Professional September 9-11, 2020